Menopause can be experienced in multiple ways, with one woman having a widely different time of it than the next. But there’s one strategy for feeling your best through this phase of life and beyond, a formula that is simple and effective. “Whole foods, a plant-forward diet, exercise, and good sleep. You can’t get around those elements as being the foundation of the house of health,” Dr. Anne Kennard told viewers recently during Part 3 of our Embrace the Change virtual series, sponsored by Nutrafol, in which we covered fitness, energy, and sleep. It’s nice that something about menopause is clear cut.
We trust Dr. Kennard’s opinion, as she is something of a Renaissance woman when it comes to wellness. She’s an OB/GYN, Integrative Medicine physician, herbalist, yoga instructor, and the author of Nourish: An Integrative Medicine Cookbook (which we’re sure a lot of our viewers ordered right after the session because she was so clear, gentle, and knowledgeable). As a bonus, Dr. Kennard has given NextTribers two recipes from her book that will help you see through the recommendations she makes.
Our other guest was Carla Kemp, a fitness expert who shares her day-to-day exercise and nutrition routines with her scores of followers on social media via her her handle: FabnFitbyCarla. At 57, she is outrageously fit and doesn’t plan on slowing down.
NextTribe launched this series in partnership with Nutrafol, which produces Women’s Balance, a specially formulated supplement that helps menopausal women take control of their hair health. Our shared aim is to encourage conversation and understanding around menopause, a condition that is too often ignored by the media and health professionals. Since its inception, NextTribe has been talking about menopause and encouraging women to share their stories of this universal experience in our Menopause Chronicles. We invite you to share yours too!
Viewers of the event were able to ask questions, and there were scores of them. What follows is an edited and condensed version of the conversation, which was moderated by NextTribe co-founder Jeannie Ralston. Three viewers who submitted questions were chosen to win three months’ worth of Nutrafol’s Women’s Balance.
Before we start with specific questions, can you give us some background on what happens physiologicially during menopause?
Dr. Kennard: Menopause is often treated as a singular event in a woman’s life. In fact, it’s more of a transition. Physiologically that means the loss of reproductive function, the cessation eventually of ovulation, and the decrease of the ovarian hormones estrogen, progesterone, and testosterone. But what that means for the whole body and the spirit–it’s a transition of womanhood. And many women will notice increase in weight or redistribution of weight, change in sleep patterns, decrease in lean body mass, and decrease in bone mass.
But what I also love to think about and celebrate is the wisdom of women after menopause. They are unapologetically owning their life and their power. Our society that celebrates youth so much is remiss. Women after the menopause transition are often the elders and the wisdom women of our society.
What happens to our energy levels during menopause?
Dr. Kennard: I hear from many women about the decrease in energy after menopause. Some it, I think, is related to changes in sleep patterns. Some is related to hormonal change. There are ways through diet and lifestyle to help improve our decreased energy after menopause.
One of my favorite supplements for energy and vitality after menopause is maca.
What can we be doing about that?
Dr. Kennard: One of the main things is optimizing sleep when possible. Energy is also very related to diet, and choosing a whole foods, plant forward, anti-inflammatory diet, low in sugar and processed foods is going to help with energy. Plus, targeted supplementation. One of my favorite supplements for energy and vitality after menopause is maca, which is studied for those elements and for libido and I was very pleased to see it’s included in Nutrafol’s Women’s Balance.
Is it normal to have periods of high energy and then crash and feel fatigue?
Dr. Kennard: I think that energy can fluctuate in menopause. I would turn a careful eye to the diet to make sure there’s enough fat, enough protein and that you’re not getting a lot of carbohydrate energy and then crashing. Lots of greens with healthy fats is going to provide a steady stream of energy. [Dr. Kennard’s women’s powerball recipe will help sustain energy.]
Carla Kemp: Some days my energy might be high and other times my energy is low. It just means that maybe I need to look at the day before. What did I eat? Am I drinking enough water? Those kinds of things.
Carla, you’ve written about how exercise helped you manage your menopause symptoms. Can you tell us about that?
Carla Kemp: Aerobic exercise helps with depression, anxiety, and mood swings that come along with menopause. I myself was lacking energy, which was a major problem for me because prior I always had tons of energy. But then in 40s and 50s, my energy is starting decrease as I was entering menopause. I thought I have to get out of this rut, what can I do? I came up with something simple, that was easy for me. I thought just go to the gym and walk on the treadmill for 15 minutes. I knew I could do that. Then started slowly increasing the time up to 30 minutes, and then I started walking faster. And my energy just started to come back. I felt better about myself. Then I incorporated other components of exercise. But walking was what got exercise back into my life.
If we’re feeling low on energy, what should we be doing to motivate ourselves to exercise and keep at it?
Carla Kemp: Find things that move you. For me, music was a big factor. I think music moves a lot of us. We hear a song. I decided to incorporate music with my exercise. I put together a playlist of favorite music. I like gospel, old school music, Aretha Franklin. Anything that will get me going. Put music on while exercising and time goes so quickly.
Classes also help. Women go to the gym and think I don’t know what to do. But in a class, you already have an instructor who has put together a program for you. All you have to do is listen to her and do what she says.
And I guess these days, virtual classes make it easer than ever, right?
With yoga, you can practice balance, do stretching and strength training. So you’ve got three of the four components right there.
Carla Kemp: One great thing about internet and social media and youtube offers anything and everything of what you want. What’s some basic exercises I can do. Google it and you can find it. Instagram, social media. A lot of trainers share their routines for free, and you can take advantage of that at home. Of course that’s what I’ve been doing the last two to three months.
What does a balanced exercise plan look like for women at our age?
Carla Kemp: Want some type of aerobic activity, what that means something that gets the heart rate up, something that will break a sweat for you. Brisk walking, jogging, swimming, taking a class, and you can start off with maybe 10 minutes per day, you don’t have to a long work out session.
The second thing is some type of strength training. And you can do that two to three times per week, 10 minutes. That’s where hand weights would come in, work out bands, you can also use your own physical body weight. That could be a modified push up, squats, burpees, planks. Those all are incorporating your own body weight.
The next component would be stretching, which helps with flexibility. That can be yoga or pilates.
The final component is some type of balance and mobility. Of course the older we get we start to lose our balance, so we’re going to want to start practicing exercises that assist with that. Standing on one foot for maybe 10 to 20 seconds. Then switch to the other. Or it could be walking in a straight line for 20 steps.
Try to incorporate all four of those. Take advantage of modifications. So instead of saying, I can’t do that. Find a modified version of that and do that until you can build the strength to do the whole movement.
But what if joint pain and other discomfort is stopping someone from exercising. What can they do about that?
Carla Kemp: You want to work through it. You definitely don’t want to stop doing anything at all. Because if you work through it gently, it will reduce the pain. You want to do low impact exercises, such as swimming or Pilates, or even strength exercise. And water aerobics is wonderful. They have hand weights and all kinds of instruments to assist you, and classes as well. So if you don’t know what to do, find a water aerobics class. Of course, always consult your doctor first.
Can you discuss how HIIT works?
Carla Kemp: HIIT stands for high impact interval training. It incorporates a fast workout in a short amount of time. Usually five different stations, at least, and you stay at one station for, say, one minute. The first station would be a high intensity workout like running in place. The second station might be hand weights, dumbbell curls. You’re getting intensity, you’re getting aerobic exercise, your heart rate is going. But you’re still doing strength training and can incorporate two different components in a short amount of time.
I know both of you practice yoga, and Dr. Kennard, you’re a yoga instructor. What are the benefits of yoga that menopausal women need to know about?
Dr. Kennard: Yoga is so adaptable to any body and any physical situation. Many people think well I’m not flexible, I can’t do yoga. Or they might be intimidated in a yoga class with people who are perceived to be in better shape or more flexible than they are.
I teach restorative yoga, chair yoga with limited mobility and disabilities. It’s remarkable; the isometrics contraction of the muscle in yoga is actually protective of the bones. Yoga for bone health. Yoga for flexibility and balance. And besides these physical benefits, I think of yoga as working in not working out. I started yoga for the physical benefits and I continue it for the mental benefits, improved sleep, improved acceptance of self and others and for cultivating kindness and compassion for myself and others.
Carla Kemp: I remember when I first started doing yoga, the teacher said, “It’s your practice.” It’s what your individual body can do so you don’t compare yourself to how far someone else is stretching or to someone bending over her head, doing all these poses that I still can’t do.
Yoga has been so rewarding. With the endorphins and all that’s happening to your body after a session, you really feel at peace. You feel you can conquer the world, and you’re going to be nice and say nice things to people. Particularly in this climate now, we all need to just breathe. Also with yoga, you can practice balance, do stretching and do strength training. So you’ve got three components right there.
Weight Gain, Diet and Metabolism
You mentioned that weight gain is common during menopause. Why does that happen?
Dr. Kennard: This is one of the main things I hear about. In menopause because of changes in hormones there’s a redistribution of body fat as well as conversion of lean body mass to fat. Many women in their late 40s and early 50s complain that they carry weight in their midsections when they hadn’t previously.
From a nutrition perspective, what I’ve found to work the best for that particular issue in that particular hormonal milieu is a combination of a lower carbohydrate diet combined with intermittent fasting or time restricted eating. There are many different ways to do this. The most user friendly way is to limit overnight eating. We’re talking about a period of at least 12 hours, say 7 p.m. to 7 a.m., where there’s no caloric intake. That seems to be good for resetting the metabolism as much as possible, and reflects in the research and in my own practice. That seems to be the one thing that people come back consistently to say makes a difference. It sensitizes the cells to insulin, it helps prevent pre-diabetes and decreases inflammation. And it does seem to help with energy and improved sleep.
So intermittent fasting is not just a fad?
Dr. Kennard: Well researched at this point. Many different ways to do it. Some not tremendously user friendly. I think going to a 12-hour fast over night is more of an ancestral way of eating. One our grandparents would recognize. It’s more modern that we don’t do that actually. It’s approved in obesity research and for diabetes. When combined with a lower carbohydrate, plant forward, limited sugar and processed foods, high phyto nutrients as well. Things like ginger, turmeric, greens. Anything with a real vibrant color. Brussel sprouts, kale, any of the sulphur-containing vegetables. Different supplements: curcumin, which is the active ingredient in turmeric in the Nutrafol product. All of those are going to support decreased inflammation and better energy and weight support
What kind of redistribution of weight are we talking about?
Dr. Kennard: It’s a shift from the hips to the bulge, just below the belly button.
Oh the muffin top! The notorious muffin top! Intermittent fasting helps with that as well?
Dr. Kennard: Yes.
What’s the science behind intermittent fasting?
Dr. Kennard: There’s a pretty deep body of evidence behind it. The main takeaways from the science are it allows the liver, which stores glucose, to get into a place of using its stored glucose instead of storing more. [Over-storage] is where you start seeing fatty liver disease and insulin resistance. Optimization of the liver’s utilization and storage of glucose is key. Diabetes generally starts not as a disorder of high sugar but insulin resistance.
By giving the cell a break per se, it improves the cell’s ability to take up glucose to be sensitive to insulin and keep the blood glucose normal. Even if someone’s not overtly diabetic, that insulin resistance can contribute to the midsection weight gain that bothers women. Time restricted eating improves both of those factors.
We hear so much from our readers about sleep problems. Why do we have so much trouble with insomnia at this stage?
Dr. Kennard: Sleep is so multifactorial. After menopause I think it’s disrupted because of the hormonal changes. There’s a difference in the thermal regulation, the set points. People often have more issues with their bladders, needing to go the bathroom at night, which is disruptive to sleep. There’s some change too in the body’s need for sleep; it decreases a little bit as we age. I do think there is mental component too: worry, anxiety and stress. Sleep has been one of the big things I’ve heard about during COVID; patients are having new onset insomnia.
And as with everything in the body, the knee bone is connected to the hip bone. Things don’t happen in isolation. When sleep is optimized, it allows the body to manage metabolism as well. And proper sleep is so important. Decreased sleep is correlated with obesity. Optimizing sleep is one of the most important things we can do for health.
Specifically related to menopause, it’s very important that the room is cool and dark. 64 to 68 degrees. A sleep hygiene routine is so important. You want to click down the list. Avoid eating a couple hours before bed. Alcohol can help relax people but it actually disrupts the sleep patterns so you may notice decreased sleep with alcohol use. That’s another quarantine issue.
Now with electronics, people are in their beds with their phones. Not only is the blue light a problem, but the scrolling, the rapid input of information into the eyes and brains, directly sets you up to be alert, awake, and have the sympathetic nervous system active. It’s not conducive to sleep. At least one hour before bed, perhaps two is prudent if you have difficulty sleeping, put away the electronics. I’m a big fan of some sort of contemplative, reflective exercise before bed. It really sets up the brain to transition into sleep.
Try thinking of sleep as letting go of waking rather than something else to do, like I have to fall asleep. Progressive relaxation, such as yoga nidra, and gentle stretching really help. Some supplements can be helpful as well. And talk to your gynecologist if bladder issues are keeping you up. That is optimizable and you don’t have to live with that.
Carla Kemp: And don’t forget exercise. Exercise does help you go to sleep, and go into a deep sleep. It’s important for the quality of sleep and the duration.
I like ashwagandha as a women’s tonic during the menopause transition and beyond.
What are some supplements that can help with sleep? Magnesium? Melatonin?
Dr. Kennard: I want to reiterate that the most potent sleep medicine is night itself. Allowing yourself to experience natural darkness through decreased electronic use, and a dark room at night. Any practices that get the brain ready for sleep.
Ashwagandha in Women’s Balance is not specifically for sleep but many women notice improved sleep in addition to other benefits. I like ashwagandha as almost a women’s tonic during the menopause transition and beyond.
Magnesium. We’ve known since about the 1920s that American soil is deficient in magnesium, so even if you’re eating magnesium rich foods like leafy greens, most Americans are magnesium deficient. I really do like that as a daily supplement for many reasons. There are different forms. Magnesium glycinate is generally well tolerated. Magnesium citrate can cause diarrhea, but if you tend toward constipation that can be a welcome side effect. You need to experiment with which form works for you.
Melatonin is safe to take long term, at least as available research. One I particularly like for women in menopause transition is hops, like what’s in beer. Hops is a vine-like plant. It can decrease nighttime wakefulness for people who wake up in the middle of the night and have a difficult time going back to sleep. It seems to decrease nighttime hot flashes as well. So if that’s contributing to poor sleep that’s an excellent consideration.
I’m worried about my thinning hair. What can I do about it?
Dr. Kennard: This is how I actually came to know about Nutrafol because I had so many patients with this concern. And I wanted to try my best to help them. Def the hormonal changes can cause hair thinning and hair loss, kind of a drier more brittle hair. The combination of the nutrients that support hair growth with the compounds like the curcumin that are anti-inflammatory and then some other things that are added into women’s balance are helpful. Women will sometimes notice a difference with HRT. And they do notice a difference with whole foods, plant forward diets, exercise and sleep.
Can menopause cause an increase in thyroid issues?
Stress affects everything. And stress hormones like cortisol are correlated with fat distribution in the midsection.
Dr. Kennard: With the caveat I can’t give specific medical advice for any individual, I will say that thyroid function does tend to change really with any hormonal shift. It changes with pregnancy, postpartum, and we’ve noticed it changes again through the menopause transition.
And many women qualify for “subclinical” hypothyroid diagnosis after menopause, where your labs haven’t shifted enough but they’re trending a little bit. Actually that’s one of the things ashwagandha is studied for, improving energy and function.
Many women improve on a gluten free diet, although the mechanism is not fully elucidated. Plus, stress affects everything. We didn’t even get into that with the midsection; stress is a huge driver of metabolic issues in the body. High stress, high cortisol levels are correlated with fat distribution in the midsection. It’s all inter-related. If people don’t sleep well they tend to have cortisol disregulation, which then further contributes to weight gain.
What can be done about bloating and digestive problems when you age?
Dr. Kennard: Bloating and digestive problems at any age and particularly through the menopause transition and afterward, is a common complaint. From a practical perspective, I tend to like the framework offered by ayurveda, which is an ancient medicine system from India. As someone is past menopause they enter more of a drier stage, that tends to slow the colon, and contribute to wind.
Try warming foods, such as warm lemon water in the morning, and warming spices like turmeric and ginger. Here’s my golden milk recipe from my cookbook. It’s a beautiful warming drink that will improve digestion.
One of the things I really love about Nutrafol’s Women’s Balance is the addition of Ashwagandha. From a digestive perspective and a sleep perspective, and actually some data shows that it decreases carbohydrate cravings and decreases body weight as well, I think that a really nice consideration for this time period.